Temporal patterns of daily occupations and personal projects relevant for older persons’ subjective health : a health promotive perspective

Sammanfattning: Engagement in daily occupations has been shown to positively influence subjective health of older persons, but there is little knowledge of how such daily occupations should be temporally structured. This thesis is guided by two concepts to explore the temporal structure of daily occupations. Firstly, the concept temporal patterns of daily occupations are used to focus internal relationships and temporal order of daily occupations during 24-hour sequences. Secondly, the concept personal projects are used to focus sets of intentionally performed occupations structured to reach short- or long-term goals of a year. The overall aim of this thesis was to develop knowledge and understanding of temporal patterns of daily occupations and personal projects relevant for older persons’ health and well-being. This thesis includes four studies, according to a multi method sequential design. Participants in all four studies were recruited from retirement organizations in two municipalities in northern Sweden and all of them are living in their private urban or rural homes. For Study I and II, data of daily occupations and of health and well-being were collected from 151 older adults using open time-diaries completed for one week and two health questionnaires. A time-geographic method was used to analyze data from the time-diaries and descriptive and analytic statistics are applied for further analysis including the additional data from the two health questionnaires. The aim of Study I was to expand the knowledge regarding temporal patterns of daily occupations and to explore and describe older Swedish adults´ daily occupations from such a temporal pattern and time-use perspective. In Study I the temporal pattern of daily occupations of older persons was identified as real time-use and added time-use during 24-hour sequences. The pattern of real time-use showed i)a daily routine of six intervals ii) characteristic profiles illustrating number of participants in categorized occupations and iii) a pattern of merged categories of occupations. The pattern of added time-use for frequencies and durations of the 24-hour sequence showed a hierarchical structure with the highest frequencies and durations shown for care for oneself occupations followed by reflection and recreation, home-keeping, procure and prepare food, and transportation occupations (Study I). The aim of Study II was to identify characteristics of temporal patterns of daily occupations that could be related to high and low health among older adults in northern Sweden. The temporal pattern of daily occupations of older persons, identified as real time-use and added time-use during 24-hour sequences, showed similar patterns for groups of older persons reporting high and low health. Persons of high health reported higher frequencies and longer durations for home-keeping, procure and prepare food, and transportation occupations and lower frequencies and shorter durations for care for oneself and reflection and recreation occupations compared to the low health group (Study II). For Study III and IV, data of personal projects relevant for health and well-being were collected by interviews with 11 older persons selected from the high health subgroup in Study II. Data was analyzed by content analysis. The aim of Study III was to explore personal projects described by older persons in northern Sweden relevant to health and well-being during the forthcoming year. A coherent project system was developed. This system was structured as five core projects representing fourteen personal projects each including two to five sequential occupations, relevant to subjective health during the forthcoming year. The project system was anchored by the core projects: keeping the family together; enjoying one’s life at home; being close to nature; cultivating oneself; and promoting conditions for healthy ageing (Study III). In Study IV variations in occupational value were interpreted from older people´s personal projects relevant for health and well-being the forthcoming year. Variations in occupational value were identified from expressions in the 14 personal projects. Value dimensions of concrete and symbolic value were identified as the most frequently expressed and self-rewarding value as the least frequently expressed. Variations in occupational value within each personal project were shown as profiles of occupational value constructing the core projects. Profiles of occupational value of the core project cultivating one-self were dominated by concrete value while the remaining core projects were dominated by symbolic value (Study IV). Conclusions: This thesis contributes with knowledge of temporal patters of daily occupations described as real and added time-use during 24-hour sequences and the characteristics of such pattern showed for high health. Furthermore, it highlights a structure for a coherent project system relevant for occupational health during a year and the imbedded occupational value. This knowledge of the older persons’ structure and experiences of occupations may be used for promoting occupational health in different contexts. Keywords: elderly, temporal routines, structure of occupations, real time-use, added time-use, time-geographic method, core projects, personal projects, occupational value, health and well-being.